Qualified Plan Intake Qualified Plan Intake PLAN TYPE * Please Select One New Existing Plan # # of Participants * 1. Entity Company Name Entity Type C Corp Select S Corp Select Non Profit Select Partnership Select LLC Select LLP Select Sole Proprietorship Select Union Select Government Agency Select Other (please list below) Select kindly specify Entity Taxed As C Corp Select S Corp Select Non Profit Select Partnership Select LLC Select LLP Select Sole Proprietorship Select Union Select Government Agency Select Other (please list below) Select kindly specify Entity Information 4. Entity Fiscal Year End (If not 12/31) 5. Entity State of Organization 6. Entity TIN/EIN 7. Entity Legal Address 8. Entity Mailing Address 9. Entity Business Phone Number 10. Entity Business Email Address * Plan Sponsor (Company) Contact: Full Name of Contact Plan Sponsor Contact is Trustee Correct Plan Sponsor Contact is not Trustee Correct Name Title Phone Fax Email Trustee Information 11. Primary Trustee of Plan: (Leave empty is same as above or) 12. Secondary Trustee of Plan (if one exists) 13. Is Secondary Trustee the Spouse of the Primary Trustee? Yes Yes No No Application for Plan EIN Responsible Party Name Responsible Party Address Responsbile Party SSN Responsible Party DOB Responsbile Party Phone Responsible Party Email Electronic Signature (Binding) Clear Date If you are human, leave this field blank. Submit Δ
